Osteoarthritis – The Next Big Bang

Osteoarthritis (OA) is the most common joint disease in the world and is a major cause of pain and disability. OA has recently been defined as ‘total joint’ failure with pathological changes in all tissues including articular cartilage, synovial inflammation, subchondrial bone thickening, marrow oedema, osteophyte formation, degenerative ligaments and in the knee the menisci. Although initially risk factors such as age, gender, trauma, overuse, genetics and obesity make contributions to initiate the process, eventually effector biochemical processes involving cartilage, bone and synovium intertwine and collectively damage the joint.

The condition is especially relevant in Asia where many countries are ageing rapidly. For most of the developed world, demographic change was a gradual process following a steady socio-economic growth over several decades. In many Asian countries the change is being compressed into two or three decade eg during the period 2008-2040, it is estimated that Singapore will increase the population of people aged 65 and over by 316%, Malaysia by 260%, Philippines by 256%. China and India will be ranked the top two countries in the absolute number of people aged 65 and over (106 and 60 millions respectively).

With regard to therapy, there are few therapeutic fields in which the need for an impartial, balanced synthesis of the evidence is as great as for osteoarthritis. The quest for the Holy Grail of OA treatment – a disease modifying osteoarthritis drug (DMOAD) remains elusive. These imperatives pose great challenges to the medical profession today. Many of us have come together to form the Asian Osteoarthritis Network and taken the first steps in a long journey. We want to thank OARSI and our many friends and pathfinders for showing us the way. The going will be long and arduous but the rewards are great.